Journal of Affective Disorders

Journal of Affective Disorders 290 (2021) 279–283

Available online 3 May 2021 0165-0327/© 2021 Published by Elsevier B.V.

Research paper

Impact of the COVID-19 pandemic on mental health service use among psychiatric outpatients in a tertiary hospital

Jun Ho Seo a,c, Se Joo Kim a, Myeongjee Lee b, Jee In Kang a,*

a Institute of Behavioral Science in Medicine & Department of Psychiatry, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, 03722, Republic of Korea b Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea c Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea

A R T I C L E I N F O

Keywords: COVID-19 Mental health service use Psychiatric disorder Time-series analysis

A B S T R A C T

Background: The aim was to explore the impact of the COVID-19 pandemic on mental health service use ac- cording to mental disorder diagnosis among psychiatric outpatients. Methods: Psychiatric outpatient visits and patient diagnostic information were extracted from the EHR(electronic health records) of a Korean tertiary hospital during 3 months of the COVID-19 pandemic and 3 months before the COVID-19 outbreak. Visit rates of psychiatric outpatients according to primary psychiatric diagnosis category before and after the COVID-19 pandemic were compared using an over-dispersed Poisson regression model. The temporal associations between the number of daily outpatient visits and the daily number of newly confirmed cases were examined by time-series analysis within each diagnosis category. Results: Total daily outpatient visit rate was significantly reduced during the pandemic. Among the nine most prevalent diagnosis categories, the daily visit rates for anxiety disorders, depressive disorders, and schizophrenia- spectrum disorders were significantly reduced by about 29.8%, 14.8%, and 13.3% respectively. Time-series analysis showed significant temporal correlations between the daily number of newly confirmed cases and the daily visit rates for anxiety disorders and depressive disorders, whereas patients with schizophrenia-spectrum disorders showed no significant temporal association. Limitations: Potential confounding factors unrelated to the pandemic might have influenced the results. Conclusions: The present findings suggest that patients with anxiety or depressive disorders may have concerns regarding the spread of COVID-19, and may be more reluctant to visit psychiatry outpatient clinics. Delivery strategies for mental healthcare services, such as telepsychiatry, would be helpful to enhance continuity of care during the pandemic.

1. Introduction

South Korea was one of the first countries outside China to face a major outbreak of coronavirus disease 2019 (COVID-19). The strong infectivity of COVID-19 and rapid increase in the number of infected people caused collective fear and health anxiety. In addition, the so- cioeconomic impact of COVID-19 under robust quarantine and surveil- lance has contributed to the development or exacerbation of various psychiatric problems. (Tull et al., 2020; Becerra-García et al., 2020; Verma and Mishra, 2020; Franchini et al., 2020; Brooks et al., 2020) An updated meta-analysis of cross-sectional community-based studies be- tween December 2019 and August 2020 during the COVID-19 pandemic

showed that anxiety in the general population increased 3-fold during the COVID-19 pandemic (estimated overall prevalence of anxiety: 25%), and that anxiety was associated with the initial or peak phase of the outbreak and several risk factors, such as the female sex, younger age, and social isolation. (Santabárbara et al., 2021) A more recent study using a large electronic health record (EHR) showed that survivors of COVID-19 were associated with an increased risk for psychiatric sequelae, and a previous psychiatric diagnosis was independently associated with an increased risk for COVID-19. (Taquet et al., 2021) While the COVID-19 pandemic could increase psychological distress and health anxiety, fear of contracting COVID-19 may increase a patient’s reluctance to visit hospitals for appointments. (Bojdani et al., 2020; Yao

* Corresponding author. E-mail address: jeeinkang@yuhs.ac (J.I. Kang).

Contents lists available at ScienceDirect

Journal of Affective Disorders

journal homepage: www.elsevier.com/locate/jad

https://doi.org/10.1016/j.jad.2021.04.070 Received 12 October 2020; Received in revised form 3 April 2021; Accepted 26 April 2021

 

 

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et al., 2020) According to data from a healthcare technology company which included more than 1600 provider organizations of the United States, a substantial cumulative reduction in outpatient visits across all medical departments, including behavioral health, was reported over the course of the pandemic in 2020. (Ateev Mehrotra et al., 2021) An Italian study of a neurology outpatient clinic showed that 30% of pa- tients suspended hospital treatments, mostly due to fear of COVID-19 infection. (Piano et al., 2020) In the field of psychiatry, another Italian study reported a reduction in the total number of voluntary psychiatry admissions in seven general hospitals of Lombardy after the COVID-19 outbreak. (Clerici et al., 2020) A recent report showed a decrease in mental health emergency service utilization in a large German psychi- atric hospital during the rapid rise of the COVID-19 pandemic. (Hoyer et al., 2020) The fear or reluctance to visit hospitals in people with pre-existing mental health problems could increase the risk of discon- tinuation of mental healthcare service use and exacerbation of psychi- atric problems. In particular, recent reports have revealed that older patients with mental disorders missed their treatments considerably after the COVID-19 outbreak. (Bojdani et al., 2020; Wong et al., 2020) While studies on mental healthcare in the pandemic have been gradually accumulated, (Rajkumar, 2020; Neelam et al., 2021; Sheridan Rains et al., 2021) there has been no study regarding the impact of the COVID-19 pandemic on the patients’ use of psychiatry outpatient ser- vices by diagnoses until the present time of March 2021. Identifying the types of mental disorder which are liable to discontinuation of mental healthcare service use during a pandemic, such as COVID-19, would be important to provide a basis for policymakers to plan appropriate de- livery method and level of support for people with different mental disorders.

We aimed to explore the impact of the COVID-19 outbreak on pat- terns of mental health service use according to mental disorder diagnosis among psychiatric outpatients in a tertiary general hospital in Korea. Since telemedicine is still illegal in South Korea, a decrease in the number of ambulatory visits would be a parameter that can reflect a reduction in healthcare utilization. We examined the number of visits by psychiatric outpatients according to psychiatric diagnosis over 3 months (Mar 2020 – May 2020) during the COVID-19 pandemic compared to 3 months (Oct 2019 – Dec 2019) before the first confirmed case of COVID- 19 in Korea (Jan. 20, 2020) (https://covid19.who.int/table). In addi- tion, we examined whether an increase or decrease in the number of daily visits to psychiatric outpatient clinics were affected by the daily number of newly confirmed cases of the COVID-19 using a Poisson regression model with time series analysis.

2. Methods

Data source and study population

Data for daily outpatient visits to the Department of Psychiatry at Severance Hospital, one of the largest tertiary general hospitals in Seoul, were collected retrospectively through the electronic health record (EHR) system. The research site hospital provides hospital-based mental health service mostly through the outpatient clinic with no community mental health teams. Data collected from Oct. 2019 to May 2020 were chosen, as we defined the periods before and during the COVID-19 pandemic as Oct. 2019 to Dec. 2019 and Mar. 2020 to May 2020, respectively. The first case of COVID-19 in South Korea was confirmed on January 20, 2020, and the daily confirmed COVID-19 cases started to exceed 100 from February 22, 2020. Visits to faculty members who consistently worked during both periods were included, and visits to faculty members who moved to a different workplace during either of the two periods were excluded to control for confounding effects asso- ciated with physician availability. Patients aged under 18 years were excluded. Data were de-identified prior to use. The daily number of confirmed COVID-19 cases in South Korea was obtained from the WHO Coronavirus Disease Dashboard (https://covid19.who.int/table). This

study was approved by the Severance Hospital Institutional Review Board.

Variables

We collected the following data for each visit: patient age, date and day of visit, psychiatric diagnoses, and whether each diagnosis was definite or putative. Then we selected only one primary definite psy- chiatric diagnosis per visit in the order of priority. All primary diagnoses by the International Classification of Diseases 10th revision (ICD-10: F0. x-F9.x) were categorized into clinically distinct groups. The following nine diagnosis groups were selected as the most prevalent among adult psychiatric outpatients at the tertiary hospital:

“Neurocognitive disorders, delirium, and other organic mental dis- orders (F0.x),” “Schizophrenia spectrum disorders (F2.x),” “Bipolar disorders (F30.x, F31.x),” “Depressive disorders (F32.x-F39.x),” “Anxi- ety disorders (F40.x, F41.x),” “Obsessive-compulsive disorders (OCD) (F42.x),” “Stress-related disorders (F43.x),” “Somatoform disorders (F45.x),” and “Sleep-related disorders (F51.x, G47.x).”

The primary variable was set as the daily number of visits.

Analytical procedures

We first investigated whether daily outpatient visit rates to the department of psychiatry were affected by COVID-19. To compare the daily number of outpatient visits during the two periods, before and during the COVID-19 pandemic, we used a Poisson regression model of the observed daily number of outpatient visits and the logarithm of daily session number was included as an offset. As overdispersion was observed in the Poisson model, we adjusted for the day of the week and a overdispersion parameter. The overdispersion parameter was estimated using the Pearson’s Chi-squared statistic. We performed subgroup analysis by psychiatric disorder group in the same way. In addition, since sex and age are important variables that can influence risk perception of the COVID-19 pandemic and unwillingness to visit healthcare service, (Bojdani et al., 2020; Wong et al., 2020; Mehra et al., 2020; Liu et al., 2020; Banerjee, 2020) the effect of sex and age was examined. In the analysis by age groups, subjects were divided into three age groups; young age group (18 to 35 years old), middle age group (36 to 55 years old), and old age group (56 years old or more). We deter- mined the age boundaries according to a previous Korean psychiatric study. (Kim and Yoon, 2018)

We then investigated the short-term effects of new daily confirmed COVID-19 cases on psychiatric outpatient clinic visits by time-series analysis using an overdispersed Poisson regression model for those psychiatric disorders with significant changes. By averaging the new daily COVID-19 cases leading up to and including the day of the visit, we constructed cumulative lag variables, lag3, lag7, and lag14, to examine the association. We adjusted for the day of the week as a covariate.

The SAS version 9.4 (SAS Institute, Cry, NC) was used for statistical analyses. A two-sided P-value less than 0.05 was considered statistically significant and the Bonferroni-adjusted method was used for the mul- tiple comparisons.

3. Results

The total daily outpatient visit rate, or the number of visits per day, during the period from March 1, 2020 to May 31, 2020 (n = 12,119, mean age, 47.8 years; 59.9% female) was reduced by about 13.1%, compared to the visit rate from October 1, 2019 to December 31, 2019 (n = 14,053, mean age, 48.3 years; 61.0% female). This reduction was statistically significant after adjustment for confounders including the daily session number of psychiatric outpatient clinics and the number of working days during each period. In addition, reduction in the total daily outpatient visit rate was observed in both males (RR = 0.900) and females (RR=0.849) (Figure S1). In the analysis by age groups, the

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reduction was also found in all the three age groups, and the reduction was observed to be larger in the old age group compared to young age group (RRs in young, middle, and old age group, 0.919, 0.876, and 0.824, respectively) (Figure S1).

Among the nine most frequent diagnosis groups, the relative risks (RRs) were statistically significant in the “schizophrenia spectrum dis- orders” group, “anxiety disorders” group, and “depressive disorders” group, while the other six groups showed no statistically significant changes between the two periods (Table 1). The “anxiety disorders” group showed the greatest reduction in the visit rate of 29.8%. Findings and detailed statistics from the subgroup analyses by sex or age groups in the “schizophrenia spectrum disorders” group, “anxiety disorders” group, and “depressive disorders” group are presented in Supplementary materials (Table S1, S2).

Among the three diagnosis groups that were shown to be signifi- cantly affected after the pandemic, the “anxiety disorders” group and “depressive disorders” group showed a significant temporal association between the daily outpatient visits and the daily number of newly confirmed cases of COVID-19. Outpatient visits among the “anxiety disorders” group decreased by an average of about 5.8% during lag 3 days, 5.5% during lag 7 days, and 5.7% during lag 14 days per 100-case daily increase in the newly confirmed COVID-19 cases. For depressive disorders, a 100-case daily increase in newly confirmed cases corre- sponded to a 4.0% decrease (lag3), 3.9% decrease (lag7), and 4.6% decrease (lag14) in visit rates. On the other hand, the “schizophrenia spectrum disorders” group did not show any significant temporal asso- ciation with the daily increase in newly confirmed cases (Table 2). Fig. 1 shows the trend lines of daily outpatient visits corresponding to the trend lines of daily confirmed COVID-19 cases in the “anxiety disorders” group and “depressive disorders” group.

4. Discussion

To the best of our knowledge, this is the first study to investigate the effect of the COVID-19 pandemic on mental healthcare service use of outpatients according to psychiatric diagnoses. The present study

showed significant decreases in psychiatric outpatient visit rates during the COVID-19 outbreak, in particular for anxiety disorders, depressive disorders, and schizophrenia-spectrum disorders. Our findings suggest that outpatients with mental health problems had poorer access to appropriate psychiatric care during the COVID-19 pandemic. Since the pandemic could increase the risk of psychiatric problems and exacerbate mental health conditions, (Zhou et al., 2020; Huang and Zhao, 2020; Frank et al., 2020) the actual reduction rates in mental health service use may be even larger than those shown in the present results. Therefore, unmet clinical needs related to psychiatric problems under viral out- breaks like COVID-19 are a critical concern, and strategies are needed to enhance continuity of mental healthcare and improve delivery to mental healthcare services.

In particular, in a time-series analysis, significant temporal correla- tions were found between the daily number of newly confirmed cases of COVID-19 and daily visit rates among outpatients with anxiety disorders and depressive disorders. Among anxiety disorders, a 100-case daily increase in new confirmed cases corresponded to a 5.8% decrease (lag3) and 5.5% decrease (lag7) in the visit rates. These results indicate that patients with anxiety or depressive disorders tended to have more sen- sitive responses to changes in the risk of viral infection and were reluctant to seek mental healthcare services, possibly due to concerns regarding the spread of COVID-19 in healthcare settings. In addition, individuals with anxiety-related disorders are more frightened about COVID-19 infection and more likely to self-isolate than those without mental disorders. (Asmundson et al., 2020) Since those with excessive worry, contamination fear, and health anxiety tend to engage in avoi- dant behaviors, anxious or depressive patients may even become housebound. (Asmundson and Taylor, 2020; Taylor and Asmundson, 2020) In addition to patient-related factors, various other factors, such as operational changes related to the pandemic, could contribute to the findings of reduced ambulatory visits. Since remote healthcare services are prohibited under the Korean medical regulations, the reduction of in-person psychiatric outpatient visits in the present Korean study is unlikely to be related to alternative healthcare service use of telemedi- cine. A possible explanation is that the patients may utilize primary hospital near their homes transiently under social distancing guidelines. Another explanation is that psychiatrists may have prescribed medica- tions for longer durations at the preceding appointment to avoid over- crowding in hospitals or due to concerns of potential travel restriction, although South Korea has not enforced travel restriction in the COVID-19 pandemic.

On the other hand, while visit rates to mental healthcare services among outpatients with schizophrenia-spectrum disorders were signif- icantly reduced after the COVID-19 outbreak compared to before the outbreak, their daily visit rates showed no significant temporal associ- ation with the daily number of newly confirmed cases of COVID-19. The different results between the psychosis group and neurosis group of anxiety and depression suggest that the decrease in mental healthcare service use seen in schizophrenic patients might be associated with reasons other than fear or health anxiety related to viral spread. Under the unique situation created by the COVID-19 pandemic, decreased casual contacts might have burdened schizophrenia-spectrum disorder patients with decreased social support and changes in routine, increasing their risk of symptom aggravation or social isolation, which might in turn have led them to disengage from treatments. (Kozloff et al., 2020; Fonseca et al., 2020; Yang et al., 2012; Sendt et al., 2015)

Unlike our expectation, patients with OCD did not show a significant reduction in visit rates during the pandemic. Previous studies reported that people with OCD were affected by worsening of the COVID-19 pandemic and exhibited clinical worsening or relapse of their OCD symptoms. (Davide et al., 2020; Fineberg et al., 2020; Benatti et al., 2020) While some people with aggravation of OCD symptoms could have increased avoidance behaviors, others may have exhibited a greater need for medication revision, reassurance, and treatment. In addition, the impact on OCD may be different according to the type of

Table 1 Comparison of psychiatry outpatient clinic visit rates between 2019.10.1–2019.12.31 and 2020.3.1–2020.5.31 by Poisson regression (refer- ence period: 2019.10.1–2019.12.31).

Diagnosis group Visits (Oct.- Dec. 2019)

Visits (March- May 2020)

RR 95%CI P-value

Total 14,053 12,119 0.869 0.831–0.908 <0.0001** Neurocognitive

disorders, delirium, and other organic mental disorders

1000 878 0.889 0.791–0.999 0.048

Schizophrenia- spectrum disorders

3261 2783 0.867 0.807–0.932 <0.0001**

Depressive disorders

2879 2440 0.852 0.787–0.923 <0.0001**

Bipolar disorders 1583 1548 1.008 0.936–1.085 0.837 Anxiety disorders 1481 1051 0.702 0.632–0.780 <0.0001** Obsessive-

compulsive disorders

624 579 0.918 0.796–1.060 0.243

Stress-related disorders

828 746 0.908 0.809–1.020 0.104

Somatoform disorders

677 581 0.860 0.759–0.974 0.018

Sleep-related disorders

978 902 0.904 0.824–0.992 0.033

RR, relative risk; CI, confidence interval; *p<0.005; **p<0.0001; overdispersion adjusted.

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symptom dimension during the pandemic; for example, subgroups with contamination symptoms could be more affected and reluctant to visit hospitals due to the fear of possible contamination. (Benatti et al., 2020) Different illness behaviors and symptom types may partially explain the lack of significant reduction in mental health outpatient services in different diagnosis groups. In addition, limited statistical power related to small sample sizes in certain groups may have led to a false negative result. Considering their nominal significance shown in the groups of somatoform disorders or sleep-related disorders, this warrants further investigation, despite the results not having survived the Bonferroni correction. Further studies with larger sample sizes are required to un- derstand how illness behaviors and seeking healthcare services are affected by individual factors among specific mental health conditions, including fear of viral spread, health anxiety, unemployment, and social isolation in response to the COVID-19 pandemic.

This study had several limitations. First, potential confounding fac- tors unrelated to the COVID-19 pandemic, including seasonal variation, might have influenced the changes in outpatient visit rates between the periods before and during the COVID-19 outbreak. Second, since this was a retrospective study with all data obtained solely from EHR and with no psychometric assessment tools, we cannot confirm which factors changed the visit rates during the pandemic. Third, since we classified the ICD-10 codes from clinician’s primary psychiatric diagnosis on EHR system, without using a structured interview, into nine diagnostic cat- egories, unmeasured diagnostic factors such as comorbid psychiatric disorders and medical diseases may bias the results of treatment compliance and dropout rates. Lastly, the present findings should not be generalized, as the results are only based on data from a tertiary hos- pital. This study should be replicated in other settings, such as in diverse regions with different disease prevalence and in different countries with

various institutional and cultural backgrounds. Since the ongoing COVID-19 pandemic could further increase social isolation, unemploy- ment, and financial distress, which are common risk factors of discon- tinuation of outpatient psychiatric treatment, (Minamisawa et al., 2016; Henzen et al., 2016; Khazaie et al., 2013) the long-term effects of the COVID-19 pandemic on mental health service use should be investigated.

5. Conclusion

In summary, we investigated the impact of the COVID-19 pandemic on psychiatry outpatient clinic use in a tertiary hospital according to psychiatric diagnosis. The “anxiety disorders” group, “depressive dis- orders” group and “schizophrenia-spectrum disorders” group showed significant reductions in mental health service use during the COVID-19 pandemic. In addition, while the visit rates of the “anxiety disorders” group and “depressive disorders” group were significantly affected by the daily number of newly confirmed cases, that of the “schizophrenia- spectrum disorders” group was not. The present findings suggest that outpatients with psychiatric disorders such as anxiety or depression may have more concerns regarding the spread of COVID-19, and may be more reluctant to visit psychiatry outpatient clinics during a pandemic. Under the pandemic situation, introduction of other service delivery methods, such as telepsychiatry, should be considered.

Contributor

Authors Jee In Kang and Jun Ho Seo designed the study and Jun Ho Seo collected the data. Author Myeongjee Lee performed the statistical analyses. Authors Jun Ho Seo, Se Joo Kim and Jee In Kang interpreted

Table 2 Changes in outpatient visits per 100-case increase in the number of new daily confirmed cases of COVID-19.

lag3 (3 days) lag7 (7 days) Lag 14 (14 days) RR 95% CI P-value RR 95% CI P-value RR 95% CI P-value

Total 0.956 0.938–0.974 <0.0001** 0.955 0.937–0.974 <0.0001** 0.950 0.930–0.970 <0.0001** Schizophrenia-spectrum disorders 0.987 0.955–1.020 0.4290 0.986 0.952–1.021 0.4220 0.989 0.951–1.028 0.5617 Depressive disorders 0.960 0.932–0.991 0.0112* 0.961 0.931–0.992 0.0135* 0.954 0.921–0.989 0.0093* Anxiety disorders 0.942 0.908–0.978 0.0017* 0.945 0.910–0.982 0.0037* 0.943 0.903–0.984 0.0074*

RR, relative risk; CI, confidence interval. * p<0.0167. ** p<0.0001; overdispersion adjusted.

Fig. 1. Trend in the number of new daily confirmed cases (solid line) and daily outpatient visits (dotted line) during the COVID-19 pandemic.

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the findings, and Jun Ho Seo and Jee In Kang prepared the main manuscript. All authors contributed to and have approved the final manuscript.

Role of funding source

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (NRF- 2019R1A2C1084611). The funding source did not have any influence on the study design, data collection, analysis and interpretation of data, writing of the report, and the decision to submit the article for publication.

Declaration of Competing Interest

The authors declare that they have no conflict of interest.

Acknowledgements

There is no acknowledgement.

Supplementary materials

Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.jad.2021.04.070.

References

Tull, M.T., Edmonds, K.A., Scamaldo, K.M., et al., 2020. Psychological Outcomes Associated with Stay-at-Home Orders and the Perceived Impact of COVID-19 on Daily Life. Psychiatry Res. 289, 113098.

Becerra-García, J.A., Giménez Ballesta, G., Sánchez-Gutiérrez, T., et al., 2020. Psychopathological symptoms during Covid-19 quarantine in spanish general population: a preliminary analysis based on sociodemographic and occupational- contextual factors. Rev. Esp. Salud Publica 94.

Verma, S., Mishra, A., 2020. Depression, anxiety, and stress and socio-demographic correlates among general Indian public during COVID-19. Int. J. Soc. Psychiatry, 20764020934508.

Franchini, L., Ragone, N., Seghi, F., et al., 2020. Mental health services for mood disorder outpatients in Milan during COVID-19 outbreak: the experience of the health care providers at San Raffaele hospital. Psychiatry Res. 292, 113317.

Brooks, S.K., Webster, R.K., Smith, L.E., et al., 2020. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 395, 912–920.

Santabárbara, J., Lasheras, I., Lipnicki, D.M., et al., 2021. Prevalence of anxiety in the COVID-19 pandemic: an updated meta-analysis of community-based studies. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 109, 110207.

Taquet, M., Luciano, S., Geddes, J.R., et al., 2021. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. The Lancet Psychiatry 8, 130–140.

Bojdani, E., Rajagopalan, A., Chen, A., et al., 2020. COVID-19 Pandemic: impact on psychiatric care in the United States. Psychiatry Res. 289, 113069.

Yao, H., Chen, J.-.H., Xu, Y.-.F., 2020. Patients with mental health disorders in the COVID-19 epidemic. The Lancet Psychiatry 7, e21.

Ateev Mehrotra, M.C., Linetsky, David, Hatch, Hilary, Cutler, David, Schneider, Eric C., 2021. The Impact of COVID-19 On Outpatient Visits in 2020: Visits Remained Stable, Despite a Late Surge in Cases. Commonwealth Fund.

Piano, C., Di Stasio, E., Primiano, G., et al., 2020. An Italian Neurology Outpatient Clinic Facing SARS-CoV-2 Pandemic: data From 2,167 Patients. Front. Neurol. 11, 564.

Clerici, M., Durbano, F., Spinogatti, F., et al., 2020. Psychiatric hospitalization rates in Italy before and during COVID-19: did they change? an analysis of register data. Iran. J. Psychol. Med. 37, 283–290.

Hoyer, C., Ebert, A., Szabo, K., et al., 2020. Decreased utilization of mental health emergency service during the COVID-19 pandemic. Eur. Arch. Psychiatry Clin. Neurosci. 1–3.

Wong, S.Y.S., Zhang, D., Sit, R.W.S., et al., 2020. Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care. British J. General Practice 70, e817–ee24.

Rajkumar, R.P., 2020. COVID-19 and mental health: a review of the existing literature. Asian J. Psychiatr. 52, 102066.

Neelam, K., Duddu, V., Anyim, N., et al., 2021. Pandemics and pre-existing mental illness: a systematic review and meta-analysis. Brain Behav. Immunity – Health 10, 100177.

Sheridan Rains, L., Johnson, S., Barnett, P., et al., 2021. Early impacts of the COVID-19 pandemic on mental health care and on people with mental health conditions: framework synthesis of international experiences and responses. Soc. Psychiatry Psychiatr. Epidemiol. 56, 13–24.

Mehra, A., Rani, S., Sahoo, S., et al., 2020. A crisis for elderly with mental disorders: relapse of symptoms due to heightened anxiety due to COVID-19. Asian J. Psychiatr. 51, 102114.

Liu, N., Zhang, F., Wei, C., et al., 2020. Prevalence and predictors of PTSS during COVID- 19 outbreak in China hardest-hit areas: gender differences matter. Psychiatry Res. 287, 112921.

Banerjee, D., 2020. The Impact of Covid-19 Pandemic on Elderly Mental Health. Int. J. Geriatr. Psychiatry.

Kim, J., Yoon, S.Y., 2018. Association between socioeconomic attainments and suicidal ideation by age groups in Korea. Int. J. Soc. Psychiatry 64, 628–636.

Zhou, J., Liu, L., Xue, P., et al., 2020. Mental Health Response to the COVID-19 Outbreak in China. Am. J. Psychiatry 177, 574–575.

Huang, Y., Zhao, N., 2020. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res. 288, 112954.

Frank, A., Hörmann, S., Krombach, J., et al., 2020. COVID-19 Concerns and Worries in Patients with Mental Illness. Psychiatr. Prax. 47, 267–272.

Asmundson, G.J.G., Paluszek, M.M., Landry, C.A., et al., 2020. Do pre-existing anxiety- related and mood disorders differentially impact COVID-19 stress responses and coping? J. Anxiety Disord. 74, 102271.

Asmundson, G.J.G., Taylor, S., 2020. How health anxiety influences responses to viral outbreaks like COVID-19: what all decision-makers, health authorities, and health care professionals need to know. J. Anxiety Disord. 71, 102211.

Taylor, S., Asmundson, G.J.G., 2020. Life in a post-pandemic world: what to expect of anxiety-related conditions and their treatment. J. Anxiety Disord. 72, 102231.

Kozloff, N., Mulsant, B.H., Stergiopoulos, V., et al., 2020. The COVID-19 Global Pandemic: implications for People With Schizophrenia and Related Disorders. Schizophr. Bull.

Fonseca, L., Diniz, E., Mendonça, G., et al., 2020. Schizophrenia and COVID-19: risks and recommendations. Revista brasileira de psiquiatria (Sao Paulo, Brazil: 1999) 42, 236–238.

Yang, J., Ko, Y.H., Paik, J.W., et al., 2012. Symptom severity and attitudes toward medication: impacts on adherence in outpatients with schizophrenia. Schizophr. Res. 134, 226–231.

Sendt, K.V., Tracy, D.K., Bhattacharyya, S., 2015. A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry Res. 225, 14–30.

Davide, P., Andrea, P., Martina, O., et al., 2020. The impact of the COVID-19 pandemic on patients with OCD: effects of contamination symptoms and remission state before the quarantine in a preliminary naturalistic study. Psychiatry Res. 291, 113213.

Fineberg, N.A., Van Ameringen, M., Drummond, L., et al., 2020. How to manage obsessive-compulsive disorder (OCD) under COVID-19: a clinician’s guide from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive and Related Disorders Research Network (OCRN) of the European College of Neuropsychopharmacology. Compr. Psychiatry 100, 152174.

Benatti, B., Albert, U., Maina, G., et al., 2020. What happened to patients with obsessive compulsive disorder during the COVID-19 pandemic? a multicentre report from tertiary clinics in Northern Italy. Front. Psychiatry 11, 720.

Minamisawa, A., Narumoto, J., Yokota, I., et al., 2016. Evaluation of factors associated with psychiatric patient dropout at a university outpatient clinic in Japan. Patient Prefer Adherence 10, 1903–1911.

Henzen, A., Moeglin, C., Giannakopoulos, P., et al., 2016. Determinants of dropout in a community-based mental health crisis centre. BMC Psychiatry 16, 111.

Khazaie, H., Rezaie, L., de Jong, D.M., 2013. Dropping out of outpatient psychiatric treatment: a preliminary report of a 2-year follow-up of 1500 psychiatric outpatients in Kermanshah. Iran. General Hosp. Psychiatr. 35, 314–319.

J.H. Seo et al.

 

  • Impact of the COVID-19 pandemic on mental health service use among psychiatric outpatients in a tertiary hospital
    • 1 Introduction
    • 2 Methods
      • Data source and study population
      • Variables
      • Analytical procedures
    • 3 Results
    • 4 Discussion
    • 5 Conclusion
    • Contributor
    • Role of funding source
    • Declaration of Competing Interest
    • Acknowledgements
    • Supplementary materials
    • References

Mental Health system that is not seen ** important in our children’s and adolescents

Essay Topic

**Mental Health system that is not seen ** important in our children’s and adolescents

 

Assignment

Choose a debate/topic that you have a great enough interest in to write 10+ pages about. (You only need eight) The more controversial the debate, the easier you will find it to be to locate information on it. Your stance should be  very clear, do not try to ride the fence for this assignment. Take a stance and argue why that side is the best option, while also addressing the counterargument. You will use ethos, pathos, and logos, along with peer-reviewed scholarly sources to support your stance.

The argument you choose cannot have a wrong or right answer. It must be grounded in perspective. For example, you can’t argue about if climate change is real because ultimately there is a wrong or right answer to that; one side is right and the other is wrong. You can’t argue if aliens are real because they either are or they are not. You have to choose something that is based on opinion.

What should be included in your essay

Background on the topic:

The essay should include a specific background on the subject that sets up your main argument. That means having a clear history if relevant. Set up why people disagree on the subject.

Main debate and argument

The subject should have no clear wrong or right. Throughout your essay, you should have a clear argument that you’re trying to convince the opposition of. That means if you were arguing that dogs are the best pets you can have, you’re trying to convince cat lovers that dogs are better.

Evidence and support

Your argument must be supported with specific examples and research. You have to include peer-reviewed and academic sources to support your argument. You can use other research as well, but the majority of your argument must be supported through strong research.

Counter argument

In your essay, you will have to address the counterargument. That means showing the other side’s argument. You want to present it fairly and from their perspective.

Rebuttal

The rebuttal is your response to the counterargument. After showing the counterargument, you want to respond to and prove why you’re right and their not. You can challenge them directly to show why they are wrong, and if need be you can concede that they are right, but that your points still outweigh theirs.

 

 

Requirements

· Must be at least eight pages in length. That’s eight to the bottom. Go on the ninth page.

· Must adhere to all MLA requirements: 12pt, Times New Roman font, double spaced, no extra space between paragraphs, name and page number in the top right corner, proper citations.

· Works Cited page: Properly formatted as well.

· Must use at least eight outside sources, five of which must be peer-reviewed from the database or books. The other three can be credible sources found through Google. Credible means NO blogs, wiki, or overtly biased sources (unless it is to show how bias affects the opposition’s argument)

· Needs to have a counterargument followed by a rebuttal of that.

· A clear and definitive thesis that directs the paper and establishes which side of the debate you are on. It can be more than one sentence, but it must be clear.

· Must give clear background of the topic

· Must have at least four clear claims that support the stance of the paper (more are encouraged in order to meet length)

Grading criteria: 250

· +25 A Clear thesis

· Your thesis establishes your main point and argument.

· +95 Strength of claims to support the thesis

· Your body paragraphs should be comprised of your support for the thesis.

· How well your arguments are developed and supported with evidence.

· Are your arguments logical?

· +25 Strength of counterargument

· The counterargument is well supported with evidence and fully developed

· +25 Strength of rebuttal to counterargument

· Your response to the counterargument is strong, logical, and supported.

· +25 Organization

· The use of topic sentences and transition sentences

· The ordering of your essay

· +25 Research used

· The strength of the research used in your essay.

· How well you incorporate your research into your essay.

· +15 MLA

· Formatting

· Citations

· +15 Grammar

· Punctuation, spelling, syntax

Module #1:  Evidence-based practice as it relates to population-based nursing combines clinical practice and public health through the use of population health sciences in clinical practice

Module #1:  Evidence-based practice as it relates to population-based nursing combines clinical practice and public health through the use of population health sciences in clinical practice (Heller & Page, 2002). Epidemiology is the science of public health.  In addition, the focus of population-based care is on populations at risk, comparison groups, and demographic factors (Curley & Vitale, 2012).

Discussion Question for Initial Post: Select a population of your interest (I am in the mental health adolescents population) – it can be the patient group you care for in your work setting, or any group of laypeople you’re especially interested in (e.g., school children, low-income seniors). Why is a population health approach needed to promote health and wellness in this population? What are the determinants of their health status? What is the APRN role in improving health and wellness in the population you selected?

Literature Review Rubric

Literature Review Rubric Name: ___________________________ Date: ___________________ Score: __________________

 

Category Exceeds Standard Meets Standard Nearly Meets Standard Does not meet standard

Title Page Title, Your name, Course Name, Date, Instructor’s name, Institution

All relevant parts of the title page are included. The title is appropriate but is not be very concise

Some needed elements are missing.

The title page is either missing or contains inaccuracies. The title page does not follow APA style.

Introduction Clearly and concisely describes topic and its importance, why the topic was chosen, and questions to be answered.

Describes topic and its importance; fails to describe key questions

Introduction describes the topic and its importance ambiguously.

Introduction is incomplete and/or nonfocused. Does not adequately convey topic.

Review of Literature Succinctly summarizes literature without reproducing it. Good use of paraphrase and summaries of main ideas. Focus is on the literature rather than the authors. Relationship of studies to each other and to present study is apparent.

Studies are generally described in enough detail so that relationships between studies can be understood. The review contains unnecessary quotations, or poor paraphrases of the original articles.

Some of the reviewed literature seems to be inappropriate or not well- linked to the topic. Review contains many lengthy quotes. Review is basically a reproduction of the literature.

Review consists of a description of several articles with no attempts to link findings to each other or to the paper. Review is unfocused or material is inappropriate.

Conclusion of Review Engaging; reviews key questions and summarizes answers

Some attempt to summarizes key findings

Summary is vague and unfocused.

No summary or conclusion

Organizational Structure and Development of Ideas in Review

Ideas are logical and sequenced. Paragraphs are well organized; effective use of transitions to facilitate flow

Paragraph development present but not perfected

Logical organization; ideas not fully developed

Little evidence of structure or organization

Reference Section Reference page includes Reference page may leave Some references appear Reference list is more like

 

 

all and only cited articles. The articles are appropriately scholarly and appropriate to the topic. Reference section is in APA format, double spaced with hanging indent.

out a cited article or include one that is not cited. The references are scholarly. The page is in APA style with only minor errors. Contains the required number of references

inappropriate for paper. Key references are clearly cited from other sources and not likely read by the student. Reference page is generally in APA style but with many errors.

a bibliography. Fewer than required references or several references that are not scholarly or references included that are from the internet. Many format errors. Not in APA style

Format (General throughout paper)

Paper is double spaced throughout including references; appropriate headings; 1 inch margins on each side of manuscript; Paper contains the required number of pages,

Format does not meet South standards and guidelines. Paper fails to contain the required number of pages

Mechanics No errors in punctuation, capitalization, utilization and spelling. Personal pronouns (I, me, us, we, you) are NOT used. Contractions are NOT used. Slang is NOT used. Sentences are complete. Each sentence stands alone and makes sense if the sentence before and after are removed. Superfluous wording is avoided. Quotations if used are few in number and accurately cited (including page

Few errors in punctuation, capitalization, utilization spelling. Some use of contractions or personal pronouns. Some incomplete sentences, or inappropriately cited quotations.

Many errors in punctuation, capitalization, spelling, use of contractions, use of personal pronouns, incomplete sentences, or inappropriately cited quotations.

Numerous distracting errors make reading and comprehension difficult. Writing ability is well below that which is expected from a graduate level student Paper does not represent graduate level writing

 

 

numbers)

Usage Excellent word choice. No errors in sentence structure or word usage. Uses active past tense voice in review. All abbreviations are written out the first time they are used.

Almost no errors in sentence structure and word usage. Periodic incomplete sentences, problems with subject/verb agreement, or run on sentences, but not to the point of being distracting from the overall focus of the paper.

Distracting errors in sentence structure and word usage. Incomplete sentences, lack of subject/verb agreement, or run-on sentences obscure the meaning of some sentences or paragraphs.

The number of errors in grammar, usage, and sentence syntax suggests writing which is well below that expected from a graduate-level student.

Paraphrase and Quotes Uses paraphrasing and gives appropriate credit for ideas. Uses quotations only when they are essential to the understanding of an idea or concept or when it is essential to “hear” the words of the original author. Quotations contain appropriate citations and include page or paragraph numbers.

Some use of direct quotations. Quotations generally contain the appropriate citation. Quotations over 40 words are placed in a free-standing block, indented without quotation marks.

Paper contains many direct quotations where use of paraphrasing would be appropriate. Direct quotations are in the appropriate format and generally correctly cited.

Paper is generally a linking of multiple direct quotations. Many quotations lack citation or are incorrectly cited. In many instances, information from other sources is used without giving appropriate credit.

Citations All cited works are done in correct format with no errors (APA style manual, 7th edition)

Majority of cited works are done in correct format. Some inconsistencies are

Few works are cited, but format is correct

Citations are incorrectly formatted or absent.

 

 

“and” is used in citations outside of parentheses [e.g. “DeWitt and Lawther (2019) suggested that “research can be fun” (p.85). “&” is used in citations within parentheses [e.g. Researchers have reported that “research can be fun” (Dewitt & Lawther, 2019, p. 85).

evident.

The impact of COVID-19 epidemic on mental health of undergraduate students in New Jersey, cross-sectional study

Please read the article by Kecojevic et al. on “The impact of COVID-19 epidemic on mental health of undergraduate students in New Jersey, cross-sectional study” (available in the Articles section). Identify, using the following attached word document format 6310-Week1-Assignment1_Format.docx

  • Gap in the literature that the study addresses
  • Research question(s)
  • Study design
  • Population studied
  • Predictor variable(s)
  • Outcome variable(s)
  • Results (provide answer to the research question(s) based on study findings).

I encourage you to view the sample assignment and answers above to better understand what is expected for this assignment.

Therapy Modality Focus Points

Therapy Modalities

Therapy Modality Focus Points

Week X

 

 

Therapy Modality:

 

Creator:

 

Therapy used for what DSM5 Diagnoses:

(support with APA reference)

 

Emphasis of Therapy Modality:

 

Goals of Therapy Modality:

 

Notes:

 

 

 

 

References

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MindTap is designed to help you master the material. Interactive videos, animations, and activities create a learning path designed by your instructor to guide you through the course and focus on what’s important.

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Flashcards

readspeaker

progress app

MyNotes & highlights

selF QuizziNg & practice

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Theories at-a-Glance The tables in this book compare theories over a range of topics, thereby providing you with the ability to easily compare, contrast, and grasp the practical aspects of each theory. These tables also serve as invaluable resources that can be used to review the key concepts, philoso- phies, limitations, contributions to multicultural counseling, applications, techniques, and goals of all theories in this text.

The following chart provides a convenient guide to the tables in this text.

Pages

6–7 Table 1.1 Overview of Contemporary Counseling Models

62–63 Table 4.1 Ego-Defense Mechanisms

65–66 Table 4.2 Comparison of Freud’s Psychosexual Stages and Erikson’s Psychosocial Stages

432 Table 15.1 The Basic Philosophies

433–434 Table 15.2 Key Concepts

438 Table 15.3 Goals of Therapy

441–442 Table 15.4 The Therapeutic Relationship

443–444 Table 15.5 Techniques of Therapy

444–445 Table 15.6 Applications of the Approaches

446 Table 15.7 Contributions to Multicultural Counseling

447 Table 15.8 Limitations in Multicultural Counseling

448–449 Table 15.9 Contributions of the Approaches

449–450 Table 15.10 Limitations of the Approaches

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Overview of Focus Questions for the Theories For the chapters dealing with the different theories, you will have a basic understand- ing of this book if you can answer the following questions as they apply to each of the eleven theories:

Who are the key figures (founder or founders) associated with the approach?

What are some of the basic assumptions underlying this approach?

What are a few of the key concepts that are essential to this theory?

What do you consider to be the most important goals of this therapy?

What is the role the therapeutic relationship plays in terms of therapy outcomes?

What are a few of the techniques from this therapy model that you would want to incorporate into your counseling practice?

What are some of the ways that this theory is applied to client populations, settings, and treat- ment of problems?

What do you see as the major strength of this theory from a diversity perspective?

What do you see as the major shortcoming of this theory from a diversity perspective?

What do you consider to be the most significant contribution of this approach?

What do you consider to be the most significant limitation of this approach?

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Australia • Brazil • Mexico • Singapore • United Kingdom • United States

Gerald Corey California State University, Fullerton Diplomate in Counseling Psychology,

American Board of Professional Psychology

Theory and PracTice of counseling and

PsychoTheraPy Tenth Edition

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Printed in the United States of America

Print Number: 01 Print Year: 2015

© 2017, 2013, Cengage Learning

ALL RIGHTS RESERVED. No part of this work covered by the copyright herein may be reproduced, transmitted, stored, or used in any form or by any means graphic, electronic, or mechanical, including but not limited to photocopying, recording, scanning, digitizing, taping, Web distribution, information networks, or information storage and retrieval systems, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without the prior written permission of the publisher.

Theory and Practice of Counseling and Psychotherapy, Tenth Edition Gerald Corey

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To the founders and key figures of the theories presented

in this book—with appreciation for their contributions

to contemporary counseling practice.

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iv

abouT The auThor

gerald corey is Professor Emeritus of Human Services and Counseling at California State University at Fullerton. He received his doctorate in counseling from the University of Southern California. He is a Diplomate in Counseling Psy- chology, American Board of Professional Psychology; a licensed psychologist; and a National Certified Counselor. He is a Fellow of the American Psychological Associa- tion (Division 17, Counseling Psychology; and Division 49, Group Psychotherapy); a Fellow of the American Counseling Association; and a Fellow of the Association for Specialists in Group Work. He also holds memberships in the American Group Psychotherapy Association; the American Mental Health Counselors Association; the Association for Spiritual, Ethical, and Religious Values in Counseling; the Asso- ciation for Counselor Education and Supervision; and the Western Association of Counselor Education and Supervision. Both Jerry and Marianne Corey received the Lifetime Achievement Award from the American Mental Health Counselors Associ- ation in 2011, and both of them received the Eminent Career Award from ASGW in 2001. Jerry was given the Outstanding Professor of the Year Award from California State University at Fullerton in 1991. He regularly teaches both undergraduate and graduate courses in group counseling and ethics in counseling. He is the author or coauthor of 15 textbooks in counseling currently in print, along with more than 60 journal articles and book chapters. Several of his books have been translated into other languages. Theory and Practice of Counseling and Psychotherapy has been trans- lated into Arabic, Indonesian, Portuguese, Turkish, Korean, and Chinese. Theory and Practice of Group Counseling has been translated into Korean, Chinese, Spanish, and Russian. Issues and Ethics in the Helping Professions has been translated into Korean, Japanese, and Chinese.

In the past 40 years Jerry and Marianne Corey have conducted group counsel- ing training workshops for mental health professionals at many universities in the United States as well as in Canada, Mexico, China, Hong Kong, Korea, Germany, Belgium, Scotland, England, and Ireland. In his leisure time, Jerry likes to travel, hike and bicycle in the mountains, and drive his 1931 Model A Ford. Marianne and Jerry have been married since 1964. They have two adult daughters, Heidi and Cindy, two granddaughters (Kyla and Keegan), and one grandson (Corey).

Recent publications by Jerry Corey, all with Cengage Learning, include:

�� Theory and Practice of Group Counseling, Ninth Edition (and Student Manual) (2016)

�� Becoming a Helper, Seventh Edition (2016, with Marianne Schneider Corey)

�� Issues and Ethics in the Helping Professions, Ninth Edition (2015, with Mari- anne Schneider Corey, Cindy Corey, and Patrick Callanan)

�� Group Techniques, Fourth Edition (2015, with Marianne Schneider Corey, Patrick Callanan, and J. Michael Russell)

�� Groups: Process and Practice, Ninth Edition (2014, with Marianne Schnei- der Corey and Cindy Corey)

iv

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v

�� I Never Knew I Had a Choice, Tenth Edition (2014, with Marianne Schneider Corey)

�� Case Approach to Counseling and Psychotherapy, Eighth Edition (2013) �� The Art of Integrative Counseling, Third Edition (2013)

Jerry Corey is coauthor (with Barbara Herlihy) of Boundary Issues in Counseling: Multiple Roles and Responsibilities, Third Edition (2015) and ACA Ethical Standards Case- book, Seventh Edition (2015); he is coauthor (with Robert Haynes, Patrice Moulton, and Michelle Muratori) of Clinical Supervision in the Helping Professions: A Practical Guide, Second Edition (2010); he is the author of Creating Your Professional Path: Les- sons From My Journey (2010). All four of these books are published by the American Counseling Association.

He has also made several educational DVD programs on various aspects of counseling practice: (1) Ethics in Action: DVD and Workbook (2015, with Marianne Schneider Corey and Robert Haynes); (2) Groups in Action: Evolution and Challenges DVD and Workbook (2014, with Marianne Schneider Corey and Robert Haynes); (3) DVD for Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes (2013); (4) DVD for Integrative Counseling: The Case of Ruth and Lecturettes (2013, with Robert Haynes); and (5) DVD for Theory and Practice of Group Counseling (2012). All of these programs are available through Cengage Learning.

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Preface xi

PART 1

BASIC ISSUES IN COUNSELING PRACTICE

1 Introduction and Overview 1 introduction 2 Where I Stand 3 Suggestions for Using the Book 5 Overview of the Theory Chapters 6 Introduction to the Case of Stan 9 Introduction to the Case of Gwen 13

2 The Counselor: Person and Professional 17

introduction 18 The Counselor as a Therapeutic Person 18 Personal Therapy for the Counselor 20 The Counselor’s Values and the Therapeutic Process 22 Becoming an Effective Multicultural Counselor 25 Issues Faced by Beginning Therapists 28 Summary 35

3 Ethical Issues in Counseling Practice 37

introduction 38 Putting Clients’ Needs Before Your Own 38 Ethical Decision Making 39 The Right of Informed Consent 41 Dimensions of Confidentiality 42 Ethical Issues From a Multicultural Perspective 43 Ethical Issues in the Assessment Process 45 Ethical Aspects of Evidence-Based Practice 48 Managing Multiple Relationships in Counseling Practice 49 Becoming an Ethical Counselor 52 Summary 53

Where to Go From Here 53 Recommended Supplementary Readings for Part 1 54

PART 2

THEORIES AND TECHNIQUES OF COUNSELING

4 Psychoanalytic Therapy 57 introduction 58 Key Concepts 59 The Therapeutic Process 66 Application: Therapeutic Techniques and Procedures 72 Jung’s Perspective on the Development of Personality 77 Contemporary Trends: Object-Relations Theory, Self Psychology, and Relational Psychoanalysis 79 Psychoanalytic Therapy From a Multicultural Perspective 84 Psychoanalytic Therapy applied to the case of stan 85 Psychoanalytic Therapy applied to the case of gwen 87 Summary and Evaluation 89 Self-Reflection and Discussion Questions 92 Where to Go From Here 92 Recommended Supplementary Readings 93

5 Adlerian Therapy 95 introduction 98 Key Concepts 98 The Therapeutic Process 104 Application: Therapeutic Techniques and Procedures 108 Adlerian Therapy From a Multicultural Perspective 119 adlerian Therapy applied to the case of stan 121 adlerian Therapy applied to the case of gwen 122

Contents

vii

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viii Contents

Summary and Evaluation 124 Self-Reflection and Discussion Questions 126 Where to Go From Here 127 Recommended Supplementary Readings 128

6 Existential Therapy 129 introduction 132 Key Concepts 137 The Therapeutic Process 146 Application: Therapeutic Techniques and Procedures 149 Existential Therapy From a Multicultural Perspective 153 existential Therapy applied to the case of stan 155 existential Therapy applied to the case of gwen 156 Summary and Evaluation 157 Self-Reflection and Discussion Questions 160 Where to Go From Here 160 Recommended Supplementary Readings 162

7 Person-Centered Therapy 163 introduction 165 Key Concepts 170 The Therapeutic Process 171 Application: Therapeutic Techniques and Procedures 176 Person-Centered Expressive Arts Therapy 180 Motivational Interviewing 182 Person-Centered Therapy From a Multicultural Perspective 184 Person-centered Therapy applied to the case of stan 186 Person-centered Therapy applied to the case of gwen 187 Summary and Evaluation 190 Self-Reflection and Discussion Questions 193 Where to Go From Here 193 Recommended Supplementary Readings 195

8 Gestalt Therapy 197 introduction 199 Key Concepts 200 The Therapeutic Process 206

Application: Therapeutic Techniques and Procedures 211 Gestalt Therapy From a Multicultural Perspective 220 gestalt Therapy applied to the case of stan 221 gestalt Therapy applied to the case of gwen 223 Summary and Evaluation 224 Self-Reflection and Discussion Questions 227 Where to Go From Here 227 Recommended Supplementary Readings 229

9 Behavior Therapy 231 introduction 233 Key Concepts 236 The Therapeutic Process 238 Application: Therapeutic Techniques and Procedures 240 Behavior Therapy From a Multicultural Perspective 258 behavior Therapy applied to the case of stan 259 behavior Therapy applied to the case of gwen 260 Summary and Evaluation 262 Self-Reflection and Discussion Questions 265 Where to Go From Here 266 Recommended Supplementary Readings 267

10 Cognitive Behavior Therapy 269 introduction 270 Albert Ellis’s Rational Emotive Behavior Therapy 270 Key Concepts 272 The Therapeutic Process 273 Application: Therapeutic Techniques and Procedures 275 Aaron Beck’s Cognitive Therapy 281 Christine Padesky and Kathleen Mooney’s Strengths-Based Cognitive Behavioral Therapy 289 Donald Meichenbaum’s Cognitive Behavior Modification 293 Cognitive Behavior Therapy From a Multicultural Perspective 298 cognitive behavior Therapy applied to the case of stan 300 cognitive behavior Therapy applied to the case of gwen 302 Summary and Evaluation 303

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Contents ix

Self-Reflection and Discussion Questions 307 Where to Go From Here 308 Recommended Supplementary Readings 310

11 Choice Theory/Reality Therapy 311

introduction 313 Key Concepts 314 The Therapeutic Process 318 Application: Therapeutic Techniques and Procedures 320 Choice Theory/Reality Therapy From a Multicultural Perspective 327 reality Therapy applied to the case of stan 329 reality Therapy applied to the case of gwen 331 Summary and Evaluation 332 Self-Reflection and Discussion Questions 334 Where to Go From Here 334 Recommended Supplementary Readings 336

12 Feminist Therapy 337 introduction 339 Key Concepts 341 The Therapeutic Process 345 Application: Therapeutic Techniques and Procedures 348 Feminist Therapy From a Multicultural and Social Justice Perspective 354 feminist Therapy applied to the case of stan 355 feminist Therapy applied to the case of gwen 357 Summary and Evaluation 360 Self-Reflection and Discussion Questions 364 Where to Go From Here 364 Recommended Supplementary Readings 366

13 Postmodern Approaches 367 Some Contemporary Founders of Postmodern Therapies 368 Introduction to Social Constructionism 368 Solution-Focused Brief Therapy 371 Narrative Therapy 382 Postmodern Approaches From a Multicultural Perspective 390 Postmodern approaches applied to the case of stan 392

Postmodern approaches applied to the case of gwen 394 Summary and Evaluation 396 Self-Reflection and Discussion Questions 398 Where to Go From Here 399 Recommended Supplementary Readings 400

14 Family Systems Therapy 403 introduction 404 Development of Family Systems Therapy 406 A Multilayered Process of Family Therapy 409 Family Systems Therapy From a Multicultural Perspective 415 family Therapy applied to the case of stan 417 family Therapy applied to the case of gwen 420 Summary and Evaluation 422 Self-Reflection and Discussion Questions 424 Where to Go From Here 424 Recommended Supplementary Readings 425

PART 3

INTEGRATION AND APPLICATION

15 An Integrative Perspective 427 introduction 428 The Movement Toward Psychotherapy Integration 428 Issues Related to the Therapeutic Process 437 The Place of Techniques and Evaluation in Counseling 443 an integrative approach applied to the case of stan 452 an integrative approach applied to the case of gwen 455 Summary 456 Concluding Comments 457 Self-Reflection and Discussion Questions 458 Where to Go From Here 458 Recommended Supplementary Readings 459

references and suggested readings 461

name index 481

subject index 485

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Preface to Tenth Edition

T his book is intended for counseling courses for undergraduate and graduate students in psychology, counselor education, human services, and the mental

health professions. It surveys the major concepts and practices of the contemporary therapeutic systems and addresses some ethical and professional issues in counsel- ing practice. The book aims to teach students to select wisely from various theories and techniques and to begin to develop a personal style of counseling.

I have found that students appreciate an overview of the divergent contempo- rary approaches to counseling and psychotherapy. They also consistently say that the first course in counseling means more to them when it deals with them person- ally. Therefore, I stress the practical applications of the material and encourage per- sonal reflection. Using this book can be both a personal and an academic learning experience.

In this tenth edition, every effort has been made to retain the major qualities that students and professors have found useful in the previous editions: the succinct overview of the key concepts of each theory and their implications for practice, the straightforward and personal style, and the book’s comprehensive scope. Care has been taken to present the theories in an accurate and fair way. I have attempted to be simple, clear, and concise. Because many students want suggestions for supple- mentary reading as they study each therapy approach, I have included an updated reading list at the end of each chapter and a list of references for each chapter at the end of the book.

This tenth edition updates the material and refines existing discussions. Part 1 deals with issues that are basic to the practice of counseling and psychotherapy. Chapter 1 puts the book into perspective, then students are introduced to the counselor—as a person and a professional—in Chapter 2. This chapter addresses a number of topics pertaining to the role of the counselor as a person and the ther- apeutic relationship. Chapter 3 introduces students to some key ethical issues in counseling practice, and several of the topics in this chapter have been updated and expanded. Expanded coverage is given to the ACA’s 2014 Code of Ethics.

Part 2 is devoted to a consideration of 11 theories of counseling. Each of the theory chapters follows a common organizational pattern, and students can easily compare and contrast the various models. This pattern includes core topics such as key concepts, the therapeutic process, therapeutic techniques and procedures, mul- ticultural perspectives, the theory applied to the case of Stan and new to this edition to the case of Gwen, and summary and evaluation. In this tenth edition, each of the chapters in Part 2 has been revised, updated, and expanded to reflect recent trends, and references have been updated as well. Revisions were based on the recommenda- tions of experts in each theory, all of whom are listed in the Acknowledgments sec- tion. Attention was given to current trends and recent developments in the practice of each theoretical approach.

xi

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xii PrefaCe to tenth edition

Each of the 11 theory chapters summarizes key points and evaluates the con- tributions, strengths, limitations, and applications of these theories. Special atten- tion is given to evaluating each theory from a multicultural perspective as well, with a commentary on the strengths and shortcomings of the theory in working with diverse client populations. The consistent organization of the summary and evalu- ation sections makes comparing theories easier. Students are given recommenda- tions regarding where to look for further training for all of the approaches in the Where To Go From Here sections at the end of the chapter. Updated annotated lists of reading suggestions along with DVD resources are offered to stimulate students to expand on the material and broaden their learning.

In Part 3, Chapter 15 develops the notion that an integrative approach to coun- seling practice is in keeping with meeting the needs of diverse client populations in many different settings. Numerous tables and other integrating material help stu- dents compare and contrast the 11 approaches.

What’s new in This Tenth edition Features of the tenth edition include Learning Objectives for all the theory chapters; Self-Reflection and Discussion Questions at the end of each theory chapter to facilitate thinking and interaction in class; and a new Case of Gwen, who is a composite of many clients, to complement the Case of Stan feature. Guest contributor Dr. Kel- lie Kirksey describes her way of working with Gwen from each of the theoretical perspectives.

Significant changes for the tenth edition for each of the theory chapters are out- lined below:

chapter 4 Psychoanalytic Therapy �� New material on countertransference, its role in psychoanalytic therapy,

and guidelines for effectively dealing with countertransference �� Expanded discussion of brief psychodynamic therapy and its application

chapter 5 adlerian Therapy �� Revised material on the life tasks �� More emphasis on goals for the educational process of therapy �� More on the role of assessment and diagnosis �� New material on early recollections with concrete examples �� Many new examples to bring Adlerian concepts to life �� Revised discussion of reorientation and encouragement process �� Expanded discussion of Adlerian techniques

chapter 6 existential Therapy �� Revised material on existential anxiety and its implications for therapy �� Revised section on the client–therapist relationship �� Expanded discussion of tasks of the existential therapist

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PrefaCe to tenth edition xiii

chapter 7 Person-centered Therapy �� Expanded discussion of clients as active self-healers �� Updated coverage of the core conditions of congruence, unconditional

positive regard, and empathy �� More attention to the diversity of styles of therapists practicing person-

centered therapy �� More emphasis on how the basic philosophy of the person-centered

approach is appropriate for working with diverse client populations �� A new section on emotion-focused therapy, stressing the role of emotions

as a route to change �� Revised section on motivational interviewing (person-centered approach

with a twist)

chapter 8 gestalt Therapy �� Revised discussion of the role of experiments in Gestalt therapy and

how they differ from techniques and structured exercises �� New emphasis on therapist presence, the role of dialogue in therapy,

and the therapeutic relationship �� Expanded discussion of therapist authenticity and self-disclosure �� More attention to the contemporary relational approach to Gestalt

practice

chapter 9 behavior Therapy �� Increased attention to the “third-generation” or “new wave” behavior

therapies �� Updating of section on EMDR �� Expanded and updated discussion of the role of mindfulness and

acceptance strategies in contemporary behavior therapy �� New and expanded material on mindfulness-based cognitive therapy

and stress reduction �� Expanded and revised treatment of dialectical behavior therapy

chapter 10 cognitive behavior Therapy �� Major reorganization and updating of the entire chapter �� Streamlining and updating of Albert Ellis’s rational emotive behavior

therapy �� Revised and expanded coverage of Aaron Beck’s cognitive therapy �� Increased coverage of Judith Beck’s role in the development of cognitive

therapy �� New section on Christine Padesky’s strength-based cognitive behavior

therapy �� Increased attention on Donald Meichenbaum’s influence in the devel-

opment of CBT �� More clinical examples to illustrate key CBT techniques and concepts �� Expanded coverage of a comparison among the various CBT approaches

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xiv PrefaCe to tenth edition

chapter 11 choice Theory/reality Therapy �� Revision of the relationship of choice theory to reality therapy �� More practical examples of reality therapy practice

chapter 12 feminist Therapy �� Updated and expanded treatment of the principles of feminist therapy �� Increased attention given to cultural and social justice perspectives �� More emphasis on concepts of power, privilege, discrimination, and

empowerment �� Expansion of relational-cultural theory and implications for practice �� Revised and expanded discussion on therapeutic techniques and

strategies �� Revised material on strengths from a diversity perspective

chapter 13 Postmodern approaches �� Updated coverage on parallels between solution-focused brief therapy

(SFBT) and positive psychology �� Broadened discussion of the key concepts of SFBT �� More emphasis on the client-as-expert in the therapy relationship in

postmodern approaches �� More clinical examples to illustrate the use of SFBT techniques �� New material on the defining characteristics of brief therapy �� Increased emphasis on the collaborative nature of narrative therapy and

SFBT �� Revision of narrative therapy section

chapter 14 family systems Therapy �� Streamlined to focus mainly on an integrative approach to family

therapy �� More on recent developments in family systems therapy �� More attention given to feminism, multiculturalism, and postmodern

constructionism as applied to family therapy

Chapter 15 (“An Integrative Perspective”) pulls together themes from all 11 theo- retical orientations. This chapter represents a major revision of the discussion of the psychotherapy integration movement; updates of the various integrative approaches; revision of the section on integration of spirituality in counseling; added material on research demonstrating the therapeutic alliance; expanded discussion on the central role of the client in determining therapy outcomes; new section on feedback-informed treatment; and updated coverage of the conclusions from the research literature on the effectiveness of psychotherapy. New to this chapter are two cases (Stan and Gwen) that illustrate integrative approaches. Chapter 15 develops the notion that an integrative approach to counseling practice is in keeping with meeting the needs of diverse client populations in many different settings. Numerous tables and other integrating mate- rial help students compare and contrast the 11 approaches.

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PrefaCe to tenth edition xv

This text can be used in a flexible way. Some instructors will follow the sequenc- ing of chapters in the book. Others will prefer to begin with the theory chapters (Part 2) and then deal later with the student’s personal characteristics and ethical issues. The topics can be covered in whatever order makes the most sense. Readers are offered some suggestions for using this book in Chapter 1.

In this edition I have made every effort to incorporate those aspects that have worked best in the courses on counseling theory and practice that I teach. To help readers apply theory to practice, I have also revised the Student Manual, which is designed for experiential work. The Student Manual for Theory and Practice of Counseling and Psychotherapy still contains open-ended questions, many new cases for explora- tion and discussion, structured exercises, self-inventories, and a variety of activities that can be done both in class and out of class. The tenth edition features a struc- tured overview, as well as a glossary, for each of the theories, and chapter quizzes for assessing the level of student mastery of basic concepts. New to this tenth edition of the Student Manual are experiential exercises for the Case of Gwen and questions raised by experts in each of the theory chapters. Each expert addresses the same six ques- tions as applied to each of the given theories.

MindTap™ is a new online resource available to accompany this textbook. It contains the video program for Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes, a glossary of key terms, interviews with experts (questions and answers by experts in the various theories), and case examples for each of the theories illustrating ways of applying these concepts and techniques to a counseling case. A concise version of working with Stan from an integrative perspective now appears in Chapter 15. Chapter 16, “Case Illustration: An Integrative Approach in Working With Stan,” has been deleted from this edition but is available on Mind- Tap™. A chapter covering Transactional Analysis is also available on MindTap™.

Case Approach to Counseling and Psychotherapy (Eighth Edition) features experts working with the case of Ruth from the various therapeutic approaches. The case- book, which is now available online, can supplement this book or stand alone.

Accompanying this tenth edition of the text and Student Manual are lecturettes on how I draw from key concepts and techniques from the various theories pre- sented in the book. This DVD program has been developed for student purchase and use as a self-study program, and it completes an ideal learning package. The Art of Integrative Counseling (Third Edition), which expands on the material in Chapter 15 of the textbook, also complements this book.

Some professors have found the textbook and the Student Manual or MindTap™ to be ideal companions and realistic resources for a single course. Others like to use the textbook and the casebook as companions. With this revision it is now possible to have a unique learning package of several books, along with the DVD for Integra- tive Counseling: The Case of Ruth and Lecturettes. The Case Approach to Counseling and Psy- chotherapy and the Art of Integrative Counseling can also be used in a various classes, a few of which include case-management practicum, fieldwork courses, or counseling techniques courses.

Also available is a revised and updated Instructor’s Resource Manual, which includes suggestions for teaching the course, class activities to stimulate interest, PowerPoint presentations for all chapters, and a variety of test questions and a final examina- tion. This instructor’s manual is now geared for the following learning package:

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xvi PrefaCe to tenth edition

Theory and Practice of Counseling and Psychotherapy, Student Manual for Theory and Practice of Counseling and Psychotherapy, Case Approach to Counseling and Psychotherapy, The Art of Integrative Counseling, and two video programs: DVD for Integrative Counseling: The Case of Ruth and Lecturettes, and DVD for Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes.

Acknowledgments The suggestions I received from the many readers of prior editions who took the time to complete the surveys have been most helpful in the revision process. Many other people have contributed ideas that have found their way into this tenth edi- tion. I especially appreciate the time and efforts of those who participated in a pre- revision review and offered constructive criticism and supportive commentaries, as well as those professors who have used this book and provided me with feedback that has been most useful in these revisions. Those who reviewed selected parts of the manuscript of the tenth edition are:

Jude Austin, doctoral student, University of Wyoming Julius Austin, doctoral student, University of Wyoming Mark E. Young, University of Central Florida Robert Haynes, Borderline Productions Beverly Palmer, California State University at Dominguez Hills James Robert Bitter, East Tennessee State University Patricia Robertson, East Tennessee State University Jamie Bludworth, Arizona State University Michelle Muratori, Johns Hopkins University Jake Morris, Lipscomb University

Special thanks are extended to the chapter reviewers, who provided consultation and detailed critiques. Their insightful and valuable comments have generally been incorporated into this edition:

�� Chapter 4 (Psychoanalytic Therapy): William Blau, Copper Mountain College, Joshua Tree, California

�� Chapter 5 (Adlerian Therapy): Matt Englar-Carlson, California State University, Fullerton; Jon Carlson, Governors State University; Jon Sperry, Lynn University, Boca Raton. James Robert Bitter, East Tennessee State University, and I coau- thored Chapter 5.

�� Chapter 6 (Existential Therapy): Emmy van Deurzen, New School of Psy- chotherapy and Counselling, London, England, and University of Sheffield; J. Michael Russell of California State University, Fullerton; David N. Elkins, Graduate School of Education and Psychology, Pepperdine University; Bryan Farha, Oklahoma City College

�� Chapter 7 (Person-Centered Therapy): Natalie Rogers, Person-Centered Expres- sive Arts Associates, Cotati, California; David N. Elkins, Graduate School of Education and Psychology, Pepperdine University; David Cain, California

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PrefaCe to tenth edition xvii

School of Professional Psychology at Alliant International University, San Diego

�� Chapter 8 (Gestalt Therapy): Jon Frew, Private Practice, Vancouver, Washing- ton, and Pacific University, Oregon; Lynne Jacobs, Pacific Gestalt Institute in Los Angeles; Gary Yontef, Pacific Gestalt Institute in Los Angeles; Jude Austin, doctoral student, University of Wyoming; Julius Austin, doctoral student, Uni- versity of Wyoming

�� Chapter 9 (Behavior Therapy): Sherry Cormier, West Virginia University; Frank M. Dattilio, Harvard Medical School, and the University of Pennsylvania School of Medicine; Ronald D. Siegel, Harvard Medical School

�� Chapter 10 (Cognitive Behavior Therapy): Sherry Cormier, West Virginia University; Christine A. Padesky, Center for Cognitive Therapy at Huntington Beach, California; Frank M. Dattilio, Harvard Medical School, and the University of Pennsylvania School of Medicine; Beverly Palmer, California State University at Dominguez Hills; Jamie Bludworth, Arizona State University; Jude Austin, doctoral student, University of Wyoming; Julius Austin, doctoral student, University of Wyoming; Jon Sperry, Lynn University, Boca Raton; Debbie Joffe Ellis

�� Chapter 11 (Choice Theory/Reality Therapy): Robert Wubbolding, Center for Reality Therapy, Cincinnati, Ohio

�� Chapter 12 (Feminist Therapy): Carolyn Zerbe Enns, Cornell College; James Robert Bitter, East Tennessee State University; Patricia Robertson, East Ten- nessee State University; Elizabeth Kincade, Indiana University of Pennsylvania; Susan Rachael Seem, The College at Brockport, State University of New York; Kellie Kirksey, Cleveland Institute of Wellness; Amanda La Guardia of Sam Houston State University. Barbara Herlihy, University of New Orleans, and I coauthored Chapter 12.

�� Chapter 13 (Postmodern Approaches): John Winslade, California State University, San Bernardino; John Murphy, University of Central Arkansas

�� Chapter 14 (Family Systems Therapy): James Robert Bitter, East Tennessee State University, and I co-authored Chapter 14.

�� Chapter 15 (An Integrative Perspective): Scott D. Miller, The International Center for Clinical Excellence; Beverly Palmer, California State University at Dominguez Hills; Jude Austin, doctoral student, University of Wyoming; Julius Austin, doctoral student, University of Wyoming

�� The Case of Gwen (all theory chapters) was written by Kellie Kirksey, Cleveland Clinic Center for Integrative Medicine

This book is the result of a team effort, which includes the combined efforts of a number of people at Cengage Learning. These people include Jon-David Hague, Product Director; Julie Martinez, Product Manager, Counseling, Human Services, and Social Work; Vernon Boes, Art Director, for his work on the interior design and cover of this book; Kyra Kane, Associate Content Developer, who coordinates the

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xviii PrefaCe to tenth edition

MindTap™ program and other supplementary materials for the book; Michelle Muratori, Johns Hopkins University, for her work on updating the Instructor’s Resource Manual and assisting in developing other supplements; and Rita Jaramillo, Content Project Manager. Thanks to Ben Kolstad of Cenveo® Publisher Services, who coordinated the production of this book. Special recognition goes to Kay Mikel, the manuscript editor of this edition, whose exceptional editorial talents continue to keep this book reader friendly. I appreciate Susan Cunningham’s work in creat- ing and revising test items to accompany this text and in preparing the index. The efforts and dedication of all of these people certainly contribute to the high quality of this edition.

Gerald Corey

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1

1Introduction and Overview

1. Understand the author’s philosophical stance.

2. Identify suggested ways to use this book.

3. Differentiate between each contemporary counseling model discussed in this book.

4. Identify key issues within the case of Stan.

5. Identify key issues within the case of Gwen.

L e a r n i n g O b j e c t i v e s

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2 CHAPTER ONE

Introduction Counseling students can begin to acquire a counseling style tailored to their own personality by familiarizing themselves with the major approaches to therapeu- tic practice. This book surveys 11 approaches to counseling and psychotherapy, presenting the key concepts of each approach and discussing features such as the therapeutic process (including goals), the client–therapist relationship, and spe- cific procedures used in the practice of counseling. This information will help you develop a balanced view of the major ideas of each of the theories and acquaint you with the practical techniques commonly employed by counselors who adhere to each approach. I encourage you to keep an open mind and to seriously consider both the unique contributions and the particular limitations of each therapeutic system presented in Part 2.

You cannot gain the knowledge and experience you need to synthesize various approaches by merely completing an introductory course in counseling theory. This process will take many years of study, training, and practical counseling experience. Nevertheless, I recommend a personal integration as a framework for the profes- sional education of counselors. When students are presented with a single model and are expected to subscribe to it alone, their effectiveness will be limited when working with a diverse range of future clients.

An undisciplined mixture of approaches, however, can be an excuse for failing to develop a sound rationale for systematically adhering to certain concepts and to the techniques that are extensions of them. It is easy to pick and choose fragments from the various therapies because they support our biases and preconceptions. By studying the models presented in this book, you will have a better sense of how to integrate concepts and techniques from different approaches when defining your own personal synthesis and framework for counseling.

Each therapeutic approach has useful dimensions. It is not a matter of a theory being “right” or “wrong,” as every theory offers a unique contribution to understand- ing human behavior and has unique implications for counseling practice. Accepting the validity of one model does not necessarily imply rejecting other models. There is a clear place for theoretical pluralism, especially in a society that is becoming increasingly diverse.

Although I suggest that you remain open to incorporating diverse approaches into your own personal synthesis—or integrative approach to counseling—let me caution that you can become overwhelmed and confused if you attempt to learn everything at once, especially if this is your introductory course in counseling theories. A case can be made for initially getting an overview of the major theoreti- cal orientations, and then learning a particular approach by becoming steeped in that approach for some time, rather than superficially grasping many theoretical approaches. An integrative perspective is not developed in a random fashion; rather, it is an ongoing process that is well thought out. Successfully integrating concepts and techniques from diverse models requires years of reflective practice and a great deal of reading about the various theories. In Chapter 15 I discuss in more depth some ways to begin designing your integrative approach to counseling practice.

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INTROduCTION ANd OvERvIEw 3

visit CengageBrain.com or watch the dvd for the video program on Chapter 1, Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view the brief lecturette for each chapter in this book prior to reading the chapter.

Where I Stand My philosophical orientation is strongly influenced by the existential approach. Because this approach does not prescribe a set of techniques and pro- cedures, I draw techniques from the other models of therapy that are presented in this book. I particularly like to use role-playing techniques. When people reenact scenes from their lives, they tend to become more psychologically engaged than when they merely report anecdotes about themselves. I also incorporate many tech- niques derived from cognitive behavior therapy.

The psychoanalytic emphasis on early psychosexual and psychosocial develop- ment is useful. Our past plays a crucial role in shaping our current personality and behavior. I challenge the deterministic notion that humans are the product of their early conditioning and, thus, are victims of their past. But I believe that an explora- tion of the past is often useful, particularly to the degree that the past continues to influence present-day emotional or behavioral difficulties.

I value the cognitive behavioral focus on how our thinking affects the way we feel and behave. These therapies also emphasize current behavior. Thinking and feeling are important dimensions, but it can be a mistake to overemphasize them and not explore how clients are behaving. What people are doing often provides a good clue to what they really want. I also like the emphasis on specific goals and on encourag- ing clients to formulate concrete aims for their own therapy sessions and in life.

More approaches have been developing methods that involve collaboration between therapist and client, making the therapeutic venture a shared responsibil- ity. This collaborative relationship, coupled with teaching clients ways to use what they learn in therapy in their everyday lives, empowers clients to take an active stance in their world. It is imperative that clients be active, not only in their counseling sessions but in daily life as well. Homework, collaboratively designed by clients and therapists, can be a vehicle for assisting clients in putting into action what they are learning in therapy.

A related assumption of mine is that we can exercise increasing freedom to cre- ate our own future. Accepting personal responsibility does not imply that we can be anything we want to be. Social, environmental, cultural, and biological realities oftentimes limit our freedom of choice. Being able to choose must be considered in the sociopolitical contexts that exert pressure or create constraints; oppression is a reality that can restrict our ability to choose our future. We are also influenced by our social environment, and much of our behavior is a product of learning and conditioning. That being said, I believe an increased awareness of these contextual forces enables us to address these realities. It is crucial to learn how to cope with the external and internal forces that influence our decisions and behavior.

Feminist therapy has contributed an awareness of how environmental and social conditions contribute to the problems of women and men and how gender-role

LO1

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4 CHAPTER ONE

socialization leads to a lack of gender equality. Family therapy teaches us that it is not possible to understand the individual apart from the context of the system. Both family therapy and feminist therapy are based on the premise that to understand the individual it is essential to take into consideration the interpersonal dimensions and the sociocultural context rather than focusing primarily on the intrapsychic domain. This comprehensive approach to counseling goes beyond understanding our internal dynamics and addresses the environmental and systemic realities that influence us.

My philosophy of counseling challenges the assumption that therapy is exclu- sively aimed at “curing” psychological “ailments.” Such a focus on the medical model restricts therapeutic practice because it stresses deficits rather than strengths. Instead, I agree with the postmodern approaches (see Chapter 13), which are grounded on the assumption that people have both internal and external resources to draw upon when constructing solutions to their problems. Therapists will view these individuals quite differently if they acknowledge that their clients possess competencies rather than pathologies. I view each individual as having resources and competencies that can be discovered and built upon in therapy.

Psychotherapy is a process of engagement between two people, both of whom are bound to change through the therapeutic venture. At its best, this is a collabora- tive process that involves both the therapist and the client in co-constructing solu- tions regarding life’s tasks. Most of the theories described in this book emphasize the collaborative nature of the practice of psychotherapy.

Therapists are not in business to change clients, to give them quick advice, or to solve their problems for them. Instead, counselors facilitate healing through a pro- cess of genuine dialogue with their clients. The kind of person a therapist is remains the most critical factor affecting the client and promoting change. If practitioners possess wide knowledge, both theoretical and practical, yet lack human qualities of compassion, caring, good faith, honesty, presence, realness, and sensitivity, they are more like technicians. I believe that those who function exclusively as technicians do not make a significant difference in the lives of their clients. It is essential that coun- selors explore their own values, attitudes, and beliefs in depth and work to increase their own awareness. Throughout the book I encourage you to find ways to apply what you are reading to your personal life. Doing so will take you beyond a mere academic understanding of these theories.

With respect to mastering the techniques of counseling and applying them appropriately and effectively, it is my belief that you are your own very best tech- nique. Your engagement with your clients is useful in moving the therapeutic pro- cess along. It is impossible to separate the techniques you use from your personality and the relationship you have with your clients.

Administering techniques to clients without regard for the relationship vari- ables is ineffective. Techniques cannot substitute for the hard work it takes to develop a constructive client–therapist relationship. Although you can learn atti- tudes and skills and acquire certain knowledge about personality dynamics and the therapeutic process, much of effective therapy is the product of artistry. Counseling entails far more than becoming a skilled technician. It implies that you are able to establish and maintain a good working relationship with your clients, that you can draw on your own experiences and reactions, and that you can identify techniques suited to the needs of your clients.

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INTROduCTION ANd OvERvIEw 5

As a counselor, you need to remain open to your own personal development and to address your personal problems. The most powerful ways for you to teach your clients is by the behavior you model and by the ways you connect with them. I sug- gest you experience a wide variety of techniques yourself as a client. Reading about a technique in a book is one thing; actually experiencing it from the vantage point of a client is quite another. If you have practiced mindfulness exercises, for example, you will have a much better sense for guiding clients in the practice of becoming increas- ingly mindful in daily life. If you have carried out real-life homework assignments as part of your own self-change program, you can increase your empathy for clients and their potential problems. Your own anxiety over self-disclosing and addressing personal concerns can be a most useful anchoring point as you work with the anxiet- ies of your clients. The courage you display in your own personal therapy will help you appreciate how essential courage is for your clients.

Your personal characteristics are of primary importance in becoming a counselor, but it is not sufficient to be merely a good person with good intentions. To be effective, you also must have supervised experiences in counseling and sound knowledge of counseling theory and techniques. Further, it is essential to be well grounded in the various theories of personality and to learn how they are related to theories of counseling. Your conception of the person and the individual characteristics of your client affect the interventions you will make. Differences between you and your client may require modification of certain aspects of the theories. Some practitioners make the mistake of relying on one type of intervention (supportive, confrontational, information giv- ing) for most clients with whom they work. In reality, different clients may respond better to one type of intervention than to another. Even during the course of an individual’s therapy, different interventions may be needed at different times. Prac- titioners should acquire a broad base of counseling techniques that are suitable for individual clients rather than forcing clients to fit one approach to counseling.

Suggestions for Using the Book Here are some specific recommendations on how to get the fullest value from this book. The personal tone of the book invites you to relate what you are reading to your own experiences. As you read Chapter 2, “The Counselor: Person and Profes- sional,” begin the process of reflecting on your needs, motivations, values, and life experiences. Consider how you are likely to bring the person you are becoming into your professional work. You will assimilate much more knowledge about the vari- ous therapies if you make a conscious attempt to apply the key concepts and tech- niques of these theories to your own personal life. Chapter 2 helps you think about how to use yourself as your single most important therapeutic instrument, and it addresses a number of significant ethical issues in counseling practice.

Before you study each of the theories chapters, I suggest that you at least briefly read Chapter 15, which provides a comprehensive review of the key concepts from all 11 theories presented in this textbook. I try to show how an integration of these perspectives can form the basis for creating your own personal synthesis to coun- seling. In developing an integrative perspective, it is essential to think holistically. To understand human functioning, it is imperative to account for the physical,

LO2

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6 CHAPTER ONE

emotional, mental, social, cultural, political, and spiritual dimensions. If any one of these facets of human experience is neglected, a theory is limited in explaining how we think, feel, and act.

To provide you with a consistent framework for comparing and contrasting the various therapies, the 11 theory chapters share a common format. This format includes a few notes on the personal history of the founder or another key figure; a brief historical sketch showing how and why each theory developed at the time it did; a discussion of the approach’s key concepts; an overview of the therapeutic process, including the therapist’s role and client’s work; therapeutic techniques and procedures; applications of the theory from a multicultural perspective; application of the theory to the cases of Stan and Gwen; a summary; a critique of the theory with emphasis on contributions and limitations; suggestions of how to continue your learning about each approach; and suggestions for further reading.

Refer to the Preface for a complete description of other resources that fit as a package and complement this textbook, including Student Manual for Theory and Practice of Counseling and Psychotherapy and DVD for Integrative Counseling: The Case of Ruth and Lecturettes. In addition, in DVD for Theory and Practice of Counseling and Psycho- therapy: The Case of Stan and Lecturettes I demonstrate my way of counseling Stan from the various theoretical approaches in 13 sessions and present my perspective on the key concepts of each theory in a brief lecture, with emphasis on the practical applica- tion of the theory.

Overview of the Theory Chapters I have selected 11 therapeutic approaches for this book. Table 1.1 presents an overview of these approaches, which are explored in depth in Chapters 4 through 14. I have grouped these approaches into four general categories.

Kecojevic et al. The impact of COVID-19 epidemic on mental health of undergraduate students in New Jersey, cross-sectional study.

Week 1 – Assignment 1 Rubric

 

Kecojevic et al. The impact of COVID-19 epidemic on mental health of undergraduate students in New Jersey, cross-sectional study.

Part Answers Points Earned
Gap in the literature   10
Research question   10
Study design   10
Population studied   10
Predictor variable(s)   15
Outcome variable(s)   15
Results   30
Total   100

Cultural Considerations to Care

Cultural Considerations to Care

 

Why Cultural Issues are Important in Psychotherapy?

Western culture focuses on the individualistic values and is wildly different than Eastern cultures (Armstrong, 2021).

Not realizing this core difference undermines the importance of interdependence and interconnectedness support systems within culture outside of our own.

This would be counterproductive in the psychotherapy setting

Traditional psychotherapies deemphasize spiritual and cultural values that are paramount to some and a key to growth and development throughout their lives (Armstrong, 2021).

Religious and cultural values drive perception and relationships which impact mental health

Factors Impacting Access, Engagement, and the Use of Psychotherapy.

“Acculturation refers to the adaptation process when individuals from one culture are introduced to a new cultural context” (Zhou et al., 2022)

There are four levels of acculturation:

Assimilation – Adopts new culture

Separation – Rejects new culture

Integration – Combines aspects of both cultures, shown to provide best outcomes in mental health

Marginalization – Rejects both old and new cultures (Zhou et al, 2022).

Engagement and use of psychotherapies relies heavily upon the group’s collective outlook on mental health care.

Those who feel the pull of negative perception toward psychiatric care are less like to seek and participate in treatment for themselves.

What is: Korean Culture

Asian cultures promote collectiveness and interdependence within a family or social group.

Identities, beliefs and perceptions are similar within the group and must be conformed to.

Focus on external factors which way heavily on decisions (Zhou et al, 2022).

 

Hesitancy to accept psychiatric treatments are common due to fear of others judgement and the belief that grief and struggle should be private

Additional Information

America has long been considered a melting-pot for cultural differences

It is important to know what population groups are present within your community and ensure preparations have been taken to provide quality care (Corey 2016).

Asian cultures require a different approach to treatment due to external motivators and importance of privacy.

Focus cannot be solely on internal reflection and growth (Zhuo et al., 2022).

 

References

Armstrong, T. (2021). Considerations in Culturally Modifying Psychotherapy. Journal of Psychology and Christianity, 40(3), 258-262.

Corey (2016). Theory and Practice of Counseling and Psychotherapy (10th ed.). Cengage Learning EMEA. https://ambassadored.vitalsource.com/books/9781473744585

Zhou, Z., Liew, J., & Luo, W. (2022). Acculturation and disordered eating among Asian American college students: The role of objectification through a sociocultural Lens. International Journal of Environmental Research and Public Health, 19(21), 13967. https://doi.org/10.3390/ijerph192113967

Consider a population health topic that rises to the presidential agenda level.

Consider a population health topic that rises to the presidential agenda level. Which social determinant most affects this health issue? How did two recent presidents handle the problem? What would you do differently?